Report on the progress of human anatomy and physiology in the year 1843-4 / [Sir James Paget].

  • James Paget
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of human anatomy and physiology in the year 1843-4 / [Sir James Paget]. Source: Wellcome Collection.

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    account is that the blood capillaries are from l-1463rd to 1-1959th of an inch in diameter, forming a solid uniform network, with meshes not wider than the vessels themselves ; and that the distance through which blood has to pass from the smallest portal to the smallest hepatic veins is from about l-70thto l-80th of an inch. The meshes of the blood-capillarv network are occupied by the interlacing network of hepatic ducts. These are smaller than any other gland ducts yet known, being from l-900th to 1 -1340th of an inch in diameter, and have no capillaries on their wralls. Their network extends uniformly, and without any division according to lobules, through tile whole substance of the liver, and its meshes are very small. There is no anastomosis between the blood-vessels and the ducts ; but they are in contact on every side, each filling up the meshes of the network formed by the others, and both together filling every space, and forming the whole substance of the liver, except when large vessels, nerves, &c. run into it. Full accounts are given of the modes in which the demonstration of these things are obtained. Among them are injections (of necessity only very partial) of the bile-ducts; and these demonstrate, according to Weber, another form of bile- ducts, which are found imperfectly developed on the surface of the transverse and longitudinal fissures, the edges of the gall-bladder, and especially (as Mr. Kiernan also showed) at the connexion of the left lobe and the left lateral ligament. In these parts are networks of comparatively large branches of ducts, beset by cells, and having many branched appendages, which terminate in closed ends filled by cells, and which Weber names vasa aberrantia of the liver. [It does not appear that Weber and Kronenberg have made more complete injections of the hepatic-duct plexuses than Mr. Kiernan did, whose demonstration of this arrangement, so far as injections are concerned in it, is as satisfactory as theirs; for all confess the injections to have been very partial. The chief new evidence for this mode of arrangement is afforded by the microscopic examination of the uninjected ducts. I had a fortunate opportunity for confirming, to some extent, the account already given, in examining parts of a liver last summer, from a case of intense jaundice. The case was of a kind not very unfrequent, in which jaundiced persons die with coma or delirium, and other rapidly supervening signs of cerebral disturbance, and in which, after death, the liver is found pale, or orange-coloured, small, soft, but tough, generally or in most parts nearly bloodless, and with the minutest bile-ducts, in some parts, gorged with bile, although the large ones are not closed nor apparently obstructed; so that sometimes parts of the liver stand out from the rest, of a deep orange or olive colour. In this case, the distended ducts were easily traceable in thin sections of the liver, with a single lens of 1-10th inch focus; and they appeared tortuous, and freely anastomosing, so as to form an irregular network writh very small meshes. They appeared filled, not with fluid bile, but with bile-cells; and these, as seen with a higher power, were all pale yellow, and spotted here and there with brilliant j^ellow points and granules ; in some also the nuclei appeared peculiarly bright yellow.] The chief point in which these accounts differ from Mr. Kiernan’s is in denying that the component parts of the liver are arranged in lobules. This has also been denied by Henle and Mr. Bowman, who agree with Weber and Kronenberg in describing the capillary networks as solid, (i. e. extending uniformly through the liver.) They also all deny the existence of any fibro-cellular partitions dividing the liver into lobules, and even the existence of more fibro-cellular tissue than serves to invest the larger vessels, &c. of the liver. They deny also that there are any such interlobular veins and fissures as Mr. Kiernan described, and state that the smaller branches of these veins communicate by branches only just larger, if at all larger, than capillaries. Muller’s paper is w ritten chiefly for the purpose of maintaining the old view of the lobular arrangement of the liver, and contains many facts which had long ap¬ peared to me to afford satisfactory evidence of its truth. He justly observes that the complete injections of the blood-capillaries, on which the objections to the lobular arrangement of the larger vessels are founded, are not the best prepara¬ tions for demonstrating the distribution of the larger vessels, since these are sure to be concealed by the full capillaries. In less complete injections, they may be